改良盆底重建术治疗女性盆腔脏器脱垂的临床研究

目的:探讨改良盆底重建术和经阴道子宫切除术(TVH)+阴道前后壁修补术治疗盆腔脏器脱垂性疾病的临床意义。方法:回顾分析2005年6月～2008年2月60例盆腔脏器脱垂(POP)患者行改良盆底重建术(研究组)或TVH+阴道前后壁修补术(对照组)的疗效和并发症发生情况。研究组30例,包括研究1组TVH+改良盆底重建术20例,研究2组单行改良盆底重建术4例,研究3组子宫切除术后POP行改良盆底重建术6例;对照组30例。结果:(1)手术时间、术中出血量、平均住院时间,研究1组与对照组无明显差异(P>0.05);术后保留尿管时间、术后并发症发生率,研究组与对照组差异无显著性(P>0.05);(2)术后临床疗效比较:4组患者出院前测评POP-Q,分度均为0度或Ⅰ度。术后对照组阴道长度较术前明显缩短,研究组阴道长度则较术前无明显变化(P<0.05);(3)随访:术后随访平均8个月,研究组随访率100%,对照组随访率96.67%。POP-Q分度Ⅱ度及Ⅱ度以上判定为复发,研究组1例,复发率为3.33%,对照组5例复发(16.67%)(P<0.05);研究组3例出现性交不适,对照组7例诉性生活质量下降(P<0.05)。结论:TVH+阴道前后壁修补术和改良全盆底重建术均是治疗POP的有效方法。改良盆底重建术作为一种新术式,能更好地修补缺陷、实现结构重建和组织替代,其复发率低,短期疗效稳定,长期疗效有待进一步观察。

Clinical study of modified pelvic floor reconstruction in treating female pelvic organ prolapse

Objective:To investigate the clinical significance of modified pelvic floor reconstruction and transvaginal hysterectomy(TVH)plus repair of vaginal anterior and posterior wall on the treatment of pelvic organ prolapse(POP).Methods:The curative effect and complication of modified pelvic floor reconstruction or TVH was analyzed retrospectively in 60 women with POP who have undergone operation at Qilu Hospital from June 2005 to February 2008.The patients were divided into the study group and the control group,30 patients in each group respectively.In the study group,20 received TVH+ modified pelvic floor reconstruction as study group 1 and 4 received single modified pelvic floor reconstruction as study group 2 and 6 pop patients after hysterectomy received modified pelvic floor reconstruction as study group 3.In the control group,30 were given routine traditional vaginal hysterectomy plus repair of anterior and posterior wall of the vagina.Results:(1)There were no significant difference between study group 1 and the control group in the aspects such as operation time,bleeding during the operation,mean in-hospital time(P>0.05).The indwelling catheter time and the rate of complications after the operation showed no significant difference between the study group and the control group(P>0.05).(2)Clinical evaluation after operation:The POP-Q stage of all patients being out-hospital was 0 or Ⅰ.After operation,the vaginal length of the control group was significantly shorter than before,while no significant difference was shown in the study group(P<0.05).(3)Follow-up:the average follow-up time was eight months.The rate of follow-up for the study group and the control group was 100% and 96.67%,respectively.In the study group,there was one case of recurrence(3.33%).In the control group there were 5 cases of recurrence(16.67%)(P<0.05).In the study group there were 3 cases of pain in sexual life and in the control group there were 7 cases of complaint about the lowering of the quality of sexual life(P<0.05).Conclusion:Transvaginal hysterectomy plus repair of vaginal anterior and posterior wall of POP and modified total pelvic floor reconstruction are both effective ways in the treatment of POP.As a new surgical technique,modified total pelvic floor reconstruction repairs the defects and realizes the structural reconstruction and tissue replacement more effectively,and with lower recurrence rate,but the long-term effect need further observation.